http:www.cardiocirugia.sld.cu

Quant Imaging Med Surg. 2025 Jun 6;15(6):5739-5751. doi: 10.21037/qims-24-2238. Epub 2025 May 30.

ABSTRACT

BACKGROUND: Angiography-derived fractional flow reserve (AccuFFRangio) has emerged as a reliable tool for coronary functional assessment, demonstrating high concordance with invasive fractional flow reserve (FFR). This study aimed to determine the previously uninvestigated predictive value of combining AccuFFRangio with translesion gradient (TLG) following drug-coated balloon (DCB) angioplasty.

METHODS: This retrospective study included 232 patients treated with DCB angioplasty. Post-DCB AccuFFRangio and TLG were successfully measured in 218 patients. The vessels were classified according to dichotomous post-DCB AccuFFRangio and TLG. The primary endpoint was 2-year risk of target vessel failure (TVF), which is a composite of target vessel revascularization, target vessel myocardial infarction (MI), and cardiac death.

RESULTS: The optimal cutoff for post-DCB AccuFFRangio was 0.89. A post-DCB AccuFFRangio ≤0.89 was strongly associated with higher rates of TVF (14.3% vs. 2.8%; P=0.002), and a TLG of >0.03 was associated with increased rates of TVF (13.5% vs. 4.9%; P=0.046). Key predictors of adverse outcomes included male gender, smoking status, higher residual diameter stenosis, and post-DCB AccuFFRangio and TLG. In multivariate analysis, AccuFFRangio was independently predictive of TVF. The patient subgroup with high TLG and low AccuFFRangio had significantly higher rates of TVF (15.2%) as compared to the other groups (P=0.005).

CONCLUSIONS: Immediate post-DCB AccuFFRangio and TLG can be effectively used for stratifying risk and predicting long-term outcomes in patients undergoing DCB angioplasty. Post-DCB AccuFFRangio, in particular, offers significant prognostic insights beyond traditional clinical and imaging parameters, suggesting its potential as a critical tool in postangioplasty patient management.

PMID:40606399 | PMC:PMC12209666 | DOI:10.21037/qims-24-2238

Acta Inform Med. 2025;33(2):135-139. doi: 10.5455/aim.2025.33.135-139.

ABSTRACT

BACKGROUND: Minimally invasive coronary artery bypass grafting (MICS CABG) via left anterior thoracotomy has emerged as a less invasive alternative to conventional open sternotomy (OPEN CABG), offering potential benefits in perioperative outcomes and complication rates.

OBJECTIVE: The aim of this study was to compare procedural characteristics, ventilation duration, drainage volumes, and postoperative complications between MICS CABG and OPEN CABG in a single-center cohort in Bosnia and Herzegovina.

METHODS: This retrospective cross-sectional study included 262 patients who underwent surgical revascularization between January 2019 and June 2023.

RESULTS: MICS CABG was associated with a shorter median procedure time (2.5 vs. 3.5 hours, p<0.001) and reduced mechanical ventilation duration (11.0 vs. 14.0 hours, p<0.001). Although ICU stay was similar (3.0 days, p=0.001), total hospitalization was shorter for MICS CABG (6.0 vs. 7.0 days, p<0.001). Postoperative drainage was significantly lower at all measured time points (p<0.05), and transfusion requirements were reduced for red blood cells (0 vs. 2 units, p<0.001), fresh frozen plasma (0 vs. 2.5 units, p<0.001), and platelets (p=0.035). Use of inotropic agents was less frequent in MICS CABG, both at low (50.4% vs. 62.8%, p=0.043) and medium doses (4.0% vs. 16.0%, p=0.001). Wound infections were numerically lower in the MICS group (p=0.437).

CONCLUSIONS: Compared to open sternotomy, MICS CABG demonstrated significant advantages in operative time, ventilation duration, blood loss, and complication rates, supporting its role as a safe and effective alternative for coronary revascularization.

PMID:40606238 | PMC:PMC12212263 | DOI:10.5455/aim.2025.33.135-139

Circ Genom Precis Med. 2025 Jul 3:e004937. doi: 10.1161/CIRCGEN.124.004937. Online ahead of print.

ABSTRACT

BACKGROUND: Prior work suggests modifiable cardiovascular risk factors (CRFs) account for 80% to 90% of the risk for incident myocardial infarction. The contributions of genetic and other novel CRFs have not been simultaneously assessed in contemporary data sets.

METHODS: In the United Kingdom Biobank, CRFs were identified and Cox proportional hazards models with traditional CRFs (hypertension, diabetes, dyslipidemia, waist-to-hip ratio, diet, exercise, alcohol, and socioeconomic deprivation) and contemporary/genetic CRFs (Lp(a) [lipoprotein(a)], hsCRP [high-sensitivity C-reactive protein], familial hypercholesterolemia variants, and polygenic risk score for coronary artery disease) were constructed for coronary artery disease. Coronary artery disease was defined as a first-time myocardial infarction diagnosis or coronary revascularization. R2 was calculated for each model, and the percent contribution of each individual CRF was calculated by the R2 percent decrease after its removal.

RESULTS: Among 299 707 individuals, the mean (SD) age was 56.2 (8.1) years, and 166 533 (55.6%) were women. Over a median (interquartile range) follow-up of 11.0 (9.6-12.5) years, 17 409 (5.8%) of participants developed myocardial infarction. R2 increased from the base model (R2, 0.021 [0.020-0.022]), to the clinical model (R2, 0.045 [0.043-0.046]), to the contemporary/genetic model (R2, 0.053 [0.052-0.055]). The most powerful individual CRFs were hypertension (R2 loss, 15.2% [14.5-17.1]) and polygenic risk score for coronary artery disease (R2 loss, 12.4% [10.8-13.3]), followed by dyslipidemia (R2 loss, 3.4% [2.6-3.5]), diabetes (R2 loss, 2.2% [1.5-2.0]), hsCRP (R2 loss, 1.8% [1.5-2.0]), and Lp(a) (R2 loss, 1.5% [1.2-1.8]).

CONCLUSIONS: Novel CRFs like polygenic risk score for coronary artery disease, hsCRP, and Lp(a) have similar importance, comparable to traditional CRFs such as hypertension, dyslipidemia, and diabetes, for incident myocardial infarction, highlighting important identifiable residual risk factors.

PMID:40605734 | DOI:10.1161/CIRCGEN.124.004937

Circ J. 2025 Jul 1. doi: 10.1253/circj.CJ-25-0028. Online ahead of print.

ABSTRACT

BACKGROUND: The effect of the location of calcification in the left main coronary artery (LMCA) bifurcation on cardiovascular events remains unclear.

METHODS AND RESULTS: This retrospective study included 498 patients who underwent LMCA stenting at a single center between 2014 and 2018. Moderate or severe calcification was visually assessed by coronary angiography. The primary endpoint was 3-year target lesion failure (TLF), defined as cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization. Most patients (n=314; 63.1%) had no calcification in the LMCA bifurcation. One-segment calcification was observed in 45 (9.0%) patients, primarily in the left anterior descending artery (LAD; n=43 [8.6%]). Two-segment calcification was observed in 81 (16.3%) patients, most commonly involving the LMCA and LAD (n=70; 14.1%). Three-segment calcification was observed in 58 (11.6%) patients. Overall, 58 (11.6%) patients developed TLF within 3 years. Multivariable Cox regression analysis revealed a significant association between calcification in the left circumflex artery (LCX) and 3-year TLF (adjusted hazard ratio [aHR] 4.46; 95% confidence interval [CI] 1.81-10.99; P=0.001). In contrast, there was no significant association between calcification at the LMCA (aHR 1.29; 95% CI 0.47-3.55; P=0.623) or LAD (aHR 0.49; 95% CI 0.17-1.45; P=0.199) and the primary endpoint.

CONCLUSIONS: Moderate or severe calcification in the LCX is significantly associated with 3-year TLF in patients who have undergone LMCA stenting.

PMID:40603065 | DOI:10.1253/circj.CJ-25-0028

J Gen Intern Med. 2025 Jul 2. doi: 10.1007/s11606-025-09701-5. Online ahead of print.

ABSTRACT

BACKGROUND: Transgender and gender diverse (trans) populations are at elevated risk for atherosclerotic cardiovascular disease (ASCVD).

OBJECTIVE: Measure the association of gender identity and gender-affirming hormone therapy (GAHT) with ASCVD outcomes.

DESIGN: Cohort study.

PARTICIPANTS: Over 1 million veterans receiving care in the Veterans Health Administration.

MAIN MEASURES: Gender identity was identified via a validated natural language processing (NLP) algorithm. Incident ASCVD (acute myocardial infarction, ischemic stroke, or revascularization after the baseline date) was identified via International Classification of Diseases diagnosis codes among veterans without prevalent ASCVD. We calculated sample statistics stratified by gender identity and used Cox proportional hazard regression to assess associations of gender identity and GAHT with incident ASCVD.

KEY RESULTS: Among 1,105,082 veterans, 42,149 were classified as trans (8013 transfeminine, 7127 transmasculine, and 27,009 uncategorized trans) while 918,843 were cisgender men and 144,090 were cisgender women. During a median follow-up of 9.39 years, 92,910 veterans had incident ASCVD (2806 among trans veterans). Adjusting for age, race, Hispanic ethnicity, and sexual orientation, trans veterans had 1.52 [1.45, 1.59] and 0.92 [0.89, 0.96] times the hazard of ASCVD compared to cisgender women and cisgender men, respectively. Compared to trans veterans not receiving GAHT, GAHT among trans veterans assigned female at birth was significantly associated a reduced hazard of ASCVD (0.89 [0.80, 0.98]); GAHT was not associated with ASCVD among trans veterans assigned male at birth (0.99 [0.89, 1.09]).

LIMITATIONS: With NLP, there is potential for selection bias as clinicians may preferentially document the gender identity for trans more than cisgender veterans.

CONCLUSIONS: This is one of the first studies to examine the association of both gender identity and GAHT with incident ASCVD in veterans. Future research must comprehensively evaluate ASCVD outcomes and the effects of gender-affirming care (including hormone therapy) in trans populations.

PMID:40601199 | DOI:10.1007/s11606-025-09701-5

Res Pract Thromb Haemost. 2025 May 21;9(4):102897. doi: 10.1016/j.rpth.2025.102897. eCollection 2025 May.

ABSTRACT

BACKGROUND: The incidence of left ventricular thrombus (LVT), a significant complication postacute myocardial infarction (AMI), has seen a decline in the percutaneous coronary intervention era. Patients may not undergo coronary revascularization due to medical contraindications or patient preference.

OBJECTIVES: This study compared post-AMI LVT patients treated with or without revascularization.

METHODS: This was a retrospective study of 263 consecutive post-AMI patients diagnosed with LVT from November 2012 to January 2021, retrieved from an echocardiography database. Patients were stratified by their revascularization status.

RESULTS: Mean (SD) follow-up duration was 2.1 ± 2.1 years. Most post-AMI LVT patients underwent revascularization via percutaneous coronary intervention (71.5%; n = 188). Unrevascularized patients (24.0%; n = 63) were older (P < .001), more often female (P < .001), more comorbid, less likely to have anterior AMI (P < .001), or treated with anticoagulation (P < .001). In multivariable analysis, at least anticoagulation + P2Y12 inhibitor (adjusted hazard ratio [aHR], 1.84; 95% CI, 1.14-2.96; P = .01), but not revascularization (aHR, 1.25; 95% CI, 0.74-2.13; P = .40), was associated with LVT resolution. Both absence of revascularization (aHR, 2.30; 95% CI, 1.09-4.85; P = .03) and LVT resolution (aHR, 6.06; 95% CI, 2.99-12.3; P < .001) were associated with higher mortality after adjusting for age, sex, anemia, anterior AMI, and ejection fraction.

CONCLUSION: Lack of revascularization in post-AMI LVT patients was associated with higher mortality but not LVT resolution. Optimizing medical therapy remains a key treatment goal.

PMID:40599364 | PMC:PMC12210294 | DOI:10.1016/j.rpth.2025.102897

Sci Rep. 2025 Jul 1;15(1):21479. doi: 10.1038/s41598-025-05578-w.

ABSTRACT

Drug-Coated Balloons (DCB) have been widely used in interventional treatment for coronary artery de novo lesions. However, DCB treatment still have a certain proportion of target vessel restenosis (TLR) and adverse follow-up events. Quantitative flow ratio (QFR) loss are important indicators for evaluating long-term vascular functional changes. However, in patients with de novo lesions treated by DCB, the potential risk and protective factors affecting QFR loss remain unclear. The aim of this study was to explore the factors affecting QFR loss in patients with de novo lesion after DCB-angioplasty. Patients who underwent DCB-only intervention de novo lesions and underwent coronary angiography within 12 ± 3 months were enrolled. The QFR loss was defined as difference between the immediate post-procedure QFR and follow-up QFR. The subjects were divided into high QFR loss and low QFR loss groups according to the binary method. The predictors of QFR loss were then analyzed. A total of 115 patients with 1-year follow-up were included in this study, and the median follow-up time was 357 days. Multivariate Logistic analysis showed that patients with diabetes mellitus (OR = 4.937, 95%CI 1.497-16.278, P = 0.009) and LDL-C > 1.8 mmol/L (OR = 2.575, 95%CI 1.021-6.493, P = 0.045) was significantly associated with higher QFR loss 1 year after surgery. In patients undergoing DCB treatment for coronary de novo lesions, diabetes is an independent risk factor for late QFR loss at 1 year. Conversely, achieving LDL-C targets during follow-up is an independent protective factor against late QFR loss at 1 year.

PMID:40594463 | PMC:PMC12216008 | DOI:10.1038/s41598-025-05578-w

Sci Rep. 2025 Jul 1;15(1):21890. doi: 10.1038/s41598-025-08181-1.

ABSTRACT

In the patients receiving coronary artery bypass grafting (CABG), arterial stiffness is an independent predictor of disease-related mortality. Higher serum levels of big endothelin-1 (BigET-1) are associated with arterial stiffness. The present study aimed to determine the association between serum BigET-1 levels and arterial stiffness in patients undergoing CABG. A total of 90 patients undergoing CABG were enrolled in the study. Serum levels of BigET-1 are examined with a commercial sandwich enzyme immunoassay. If carotid-femoral pulse wave velocity (cfPWV) > 10 m/s, arterial stiffness is diagnosed. In the study cohort, 30 (33.3%) patients with arterial stiffness were older and had lower body mass index, higher rates of diabetes mellitus and hypertension, higher systolic and diastolic blood pressures, and higher serum BigET-1 levels compared to the controls. Multivariable logistic regression analysis revealed that serum BigET-1 > 1 pg/mL was an independent predictor of arterial stiffness (odds ratio 17.492, 95% confidence interval 2.728-112.147, p = 0.003). Multivariable linear regression analysis revealed that cfPWV significantly correlated with age (β = 0.238, adjusted R2 change = 0.043, p = 0.004), systolic blood pressure (β = 0.251, adjusted R2 change = 0.102, p = 0.002), and BigET-1 level (β = 0.533, adjusted R2 change = 0.387, p < 0.001). Increased serum BigET-1 levels were associated with arterial stiffness in patients undergoing CABG.

PMID:40593258 | PMC:PMC12219143 | DOI:10.1038/s41598-025-08181-1

Cardiovasc Revasc Med. 2025 Jun 20:S1553-8389(25)00305-7. doi: 10.1016/j.carrev.2025.06.019. Online ahead of print.

ABSTRACT

BACKGROUND: Left main coronary artery disease (LMCAD) complexity is assessed using the SYNTAX score. High scores may reflect complex LM lesions or multivessel disease. Evidence on the prognosis of these distinct populations is scarce.

METHODS: Patients undergoing percutaneous coronary intervention (PCI) for unprotected LMCAD were categorized into four groups based on LM lesion location (Body/Ostial vs. Bifurcation) and non-LM SYNTAX score (≤8 vs. >8). The reference group was Body/Ostial cases with low non-LM score. The primary endpoint was Major Adverse Cardiac Events (MACE), composite of death, myocardial infarction, or target vessel revascularization (TVR) at 1 year.

RESULTS: Out of 869 patients undergoing LM PCI, 69.2 % had a LM bifurcation lesion, and 44.8 % non-LM SYNTAX score >8. Patients with high non-LM score (>8) were older, had higher rates of chronic kidney disease, and were more likely to present with congestive heart failure or low ejection fraction. After adjustment, both groups with LM bifurcation disease had higher rates of 1-year MACE, driven by TVR. In contrast, there was no difference between the Body/Ostial lesion with high non-LM score group and the reference group.

CONCLUSION: Amongst patients undergoing LM PCI, those with LM bifurcation lesions are more likely to require repeat revascularization, regardless of non-LM SYNTAX score. Lesion complexity should be considered separately from the number of lesions.

PMID:40592694 | DOI:10.1016/j.carrev.2025.06.019

Clin Cardiol. 2025 Jul;48(7):e70170. doi: 10.1002/clc.70170.

ABSTRACT

BACKGROUND: High-intensity statins are recommended for patients with chronic coronary artery disease, with reports suggesting improved clinical outcomes. However, recent findings in coronary artery bypass graft (CABG) patients question whether a treat-to-target low density lipoprotein (LDL) approach is non-inferior to high-intensity statin therapy.

METHODS: This single-center observational study analyzed all CABG only (n = 1854) procedures performed between 2013 and 2015. Patients were divided into three groups based on statin prescription: high-intensity statin therapy (atorvastatin ≥ 40 mg or rosuvastatin ≥ 20 mg), low/moderate-intensity statin therapy, and a no-statin group. The primary outcome measured was major adverse cardiovascular events (MACE), a composite of post-CABG acute coronary syndrome, cerebrovascular accident and cardiovascular mortality.

RESULTS: No-Statin group had significantly higher incidence of MACE compared to statin group (14.2% vs 8.9%; odds ratio (OR) 1.60, 95% confidence interval (CI) 1.055-2.427, p = 0.029). Low/moderate-intensity therapy (n = 1301) was associated with a numerically higher overall rate of MACE compared to high-intensity therapy (n = 397) but was not statistically significant (9.6% vs 6.6%; OR 1.45, CI 0.961-2.172, p = 0.073). Beyond 2 years post-CABG, low/moderate intensity statin use was associated with a significant higher incidence of MACE (9.1% vs 5.3%; OR 1.72, 95% CI 0.993-2.978, p = 0.047) compared to high intensity statins. Patients who received high-intensity statin therapy had the lowest LDL levels (82.21 ± 41.85 mg/dL), compared to those on low/moderate-intensity statins (90.84 ± 45.89 mg/dL) and no-statin group (104.83 ± 38.93 mg/dL, p < 0.001).

CONCLUSION: High-intensity statin therapy following CABG is associated with improved long-term clinical outcomes compared to low- or moderate-intensity statin regimens.

PMID:40590628 | PMC:PMC12210389 | DOI:10.1002/clc.70170

Eur Heart J. 2025 Jul 1:ehaf284. doi: 10.1093/eurheartj/ehaf284. Online ahead of print.

ABSTRACT

The diagnosis of refractory angina has conventionally been limited to patients with angina and ischaemia secondary to obstructive atherosclerotic epicardial coronary disease who experience persistent symptoms despite optimal pharmacological and revascularization therapies. It is now well-established that angina may also be caused by ischaemia resulting from coronary microcirculatory disorders, coronary vasospasm, and bridging in the absence of obstructive epicardial coronary disease or after "successful" revascularization. This increasingly prevalent and symptomatic group of patients, with both angina and demonstrable ischaemia, have been excluded from the conventional definition of refractory angina. In patients with obstructive epicardial coronary disease, disturbed microcirculatory and vasomotor function, amongst other ischaemic mechanisms, may account for continuing symptoms despite revascularization. Under-recognition of these mechanisms results in inadequate treatment and symptom persistence. In this review, a redefinition of refractory angina is proposed to include the full spectrum of patients experiencing persistent angina despite current maximal guideline-directed medical and revascularization therapies. Systematic approaches for comprehensive investigation are suggested to identify underlying mechanisms of ischaemia and stratify treatments accordingly. The complex needs of patients with refractory angina are likely best addressed by an inter-disciplinary Angina Heart Team with the aim of improving patient symptoms, quality of life, and clinical outcomes.

PMID:40590516 | DOI:10.1093/eurheartj/ehaf284

Int J Epidemiol. 2025 Jun 11;54(4):dyaf079. doi: 10.1093/ije/dyaf079.

ABSTRACT

BACKGROUND: Migraine aura without headache was previously described as a benign condition. We investigated an association between migraine aura without headache and risks of stroke, myocardial infarction (MI) or percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), atrial fibrillation or flutter, and composite outcome (MI, PCI, and CABG).

METHODS: We conducted a nationwide, registry-based cohort study in Denmark in 2003-18, which included 755 individuals with typical aura without headache, 11 420 individuals who experience migraine with aura, 13 415 individuals who experience migraine without aura, 12 000 individuals with unspecified migraine, and a comparison cohort of 702 755 individuals aged 15-80 years randomly sampled from the general population. We computed incidence rates (IRs) per 1000 person-years (PYs) of the outcomes and hazard ratios (aHRs) adjusted for age, sex, calendar year, and pre-existing chronic conditions in Cox proportional-hazards regression analyses.

RESULTS: The IR per 1000 PYs among individuals experiencing aura without headache were 4.58 (2.09-7.07) for stroke, 2.10 (0.42-3.79) for MI or PCI, 0.69 (0.00-1.66) for CABG, and 4.95 (2.35-7.54) for atrial fibrillation or flutter. Individuals who experience aura without headache versus the comparator had increased risks of stroke [aHR: 2.58, 95% confidence interval (CI): 1.49-4.44] and atrial fibrillation or flutter (aHR: 2.22, 1.31-3.75). Associations with MI or PCI (aHR: 1.56, 0.70-3.47), CABG (aHR: 2.66, 0.66-10.65), and composite outcome (aHR: 1.65, 95% CI: 0.79-3.46) were in the same direction, but lacked precision.

CONCLUSION: Aura without headache was associated with increased risks of stroke and atrial fibrillation or flutter; associations with remaining outcomes could not be ruled out.

PMID:40587417 | DOI:10.1093/ije/dyaf079

CJC Open. 2025 Mar 26;7(6):777-783. doi: 10.1016/j.cjco.2025.03.016. eCollection 2025 Jun.

ABSTRACT

Patients with chest pain and symptoms of acute coronary syndromes account for > 600,000 emergency department (ED) visits annually in Canada. Of these patients, 85% do not have acute coronary syndromes, and most are discharged from the ED after a thorough evaluation. However, a large proportion of these patients are referred for outpatient cardiac testing after ED discharge, even though their short-term risk of major adverse cardiac events (MACE), including death, new myocardial infarction, and need for revascularization, is very small. These referrals contribute to substantial low-value healthcare utilization, and limit access for those patients who are more likely to benefit from objective testing.Existing risk-prediction tools-developed prior to the advent of new high-sensitivity cardiac troponin assays-were derived in nonrepresentative populations, and when applied to ED patients with low cardiac troponin concentrations, systematically overestimate the short-term risk of MACE.This multicentre prospective cohort study will enroll ED patients with chest pain to derive and validate a novel risk prediction tool that distinguishes patients at low risk of MACE who do not require further cardiac testing from those who may benefit from additional cardiac testing. We will enroll 6500 patients in 13 Canadian EDs and prospectively follow them to ascertain a primary outcome of MACE within 30 days after their index ED encounter. The risk-prediction tool developed in this project will guide the safe, efficient, and appropriate referral of ED patients with chest pain.

CLINICAL TRIAL REGISTRATION: NCT06743672.

PMID:40586028 | PMC:PMC12198596 | DOI:10.1016/j.cjco.2025.03.016

CJC Open. 2025 Mar 22;7(6):719-724. doi: 10.1016/j.cjco.2025.03.012. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Our institution implemented a clinical pathway to facilitate early hospital discharge (EHD) in < 48 hours post-primary percutaneous coronary intervention for low-risk ST elevation myocardial infarction. This study characterizes the exclusion criteria, barriers, safety profile, and patient satisfaction for EHD.

METHODS: We prospectively identified all patients with ST-elevation myocardial infarction between January 2023 and March 2024. Patient characteristics, potential EHD barriers and 30-day readmission rates were recorded. A postdischarge telephone survey assessed patient satisfaction. Patients discharged at ≤ 48 hours formed the EHD cohort; those discharged later comprised the non-EHD cohort. Statistical comparisons were performed using the chi-squared and Mann-Whitney U tests, with logistic regression assessing EHD barriers.

RESULTS: Among 433 STEMI patients, 65% (n = 282) were ineligible for EHD, primarily due to revascularization needs (29%) or infarct-related complications (47%). Of 151 eligible patients, 72% (n = 109) achieved EHD. Afternoon presentations were associated with higher EHD rates (82% vs 61%, odds ratio = 3.5, 95% confidence interval 1.57-7.83, P = 0.002). Rates of 30--day readmission were lower in the EHD cohort (0% vs 7%, P = 0.007). Patient satisfaction (96% vs 95%, P = 0.841), perceived appropriate length of stay (91% vs 82%, P = 0.15), and intention to attend cardiac rehabilitation (63% vs 67%, P = 0.73) were comparable between cohorts.

CONCLUSIONS: Revascularization considerations and infarct-related complications were the most common reason for exclusion. Morning or overnight admissions were potential barriers to EHD, suggesting a role for optimized discharge planning. No adverse impacts on safety or patient satisfaction occurred.

PMID:40586018 | PMC:PMC12198500 | DOI:10.1016/j.cjco.2025.03.012

Theranostics. 2025 Jun 9;15(14):6737-6752. doi: 10.7150/thno.110162. eCollection 2025.

ABSTRACT

Rationale: Myocardial ischemia reperfusion (I/R) injury is a major cause of adverse outcomes following revascularization therapy. Although alterations in metabolic activities during reperfusion have been implicated, the molecular mechanisms underlying the pathogenesis of I/R injury remain elusive. Metaxin 2 (MTX2), initially identified as a core component of protein import complexes, has recently been characterized in diverse cellular functions. Nevertheless, its involvement in myocardial I/R injury has yet to be fully elucidated. In this study, we aim to evaluate the role and the underlying mechanism of MTX2 in I/R injury. Methods: The myocardial I/R model was established, and the protein levels of MTX2 were determined at different time points following coronary occlusion. Loss-of-function and gain-of-function strategies were applied via genetic ablation or intra-myocardial adenovirus injection to ascertain the role of MTX2 in myocardial I/R injury. RNA sequencing, seahorse metabolic analysis, and mass spectrometry were conducted to uncover the underlying molecular mechanisms. Results: We observed that the expression of MTX2 was significantly decreased in I/R hearts. Tamoxifen-induced cardiomyocyte-specific deletion of Mtx2 led to aggravated myocardial I/R injury, resulting in impaired cardiac oxidative phosphorylation and glycolysis. Mechanistically, dimeric PKM2, a less active pyruvate kinase form compared with tetrameric PKM2, was found to be dramatically accumulated in Mtx2 deficiency mice after myocardial I/R surgery. The TOM37 domain of MTX2 interacted directly with PKM2 to promote PKM2 tetramerization, thereby modulating glucose metabolic flux. Pharmacological activation of PKM2 by a small-molecule PKM2 activator, TEPP-46, rescued the metabolic and functional outcomes of I/R in Mtx2 deficiency mice. Conclusions: Our results identified, for the first time, a cardioprotective role of MTX2 in modulating cardiac glucose metabolism by facilitating PKM2 tetramerization. Targeting metabolic homeostasis by restoring MTX2 might be a promising therapeutic strategy to mitigate myocardial I/R injury.

PMID:40585998 | PMC:PMC12203670 | DOI:10.7150/thno.110162

Multimed Man Cardiothorac Surg. 2025 Jun 30;2025. doi: 10.1510/mmcts.2025.048.

ABSTRACT

Total arterial, anaortic, off-pump coronary artery bypass grafting is seen by many as a complex, specialized operation; however, when broken down into its component parts, it can be approached as multiple reproducible techniques that all trainees should master. These components include skeletonized mammary harvest, construction of composite arterial grafts and off-pump cardiac surgery. In this video tutorial, we describe step-by-step approaches to each of these elements and demonstrate how these principles come together to facilitate an excellent surgical outcome for the patient: revascularization of all diseased coronary arteries with arterial grafts while avoiding arresting the heart or aortic manipulation.

PMID:40583699 | DOI:10.1510/mmcts.2025.048

Inflamm Res. 2025 Jun 30;74(1):99. doi: 10.1007/s00011-025-02058-9.

ABSTRACT

BACKGROUND: Treatment effects of anti-inflammatory therapies inhibiting the NLRP3/IL-1β/IL-6/CRP pathway in coronary artery disease (CAD) had conflicting results. The study aims to evaluate efficacy and safety outcomes of treatments inhibiting this pathway.

METHODS: Cochrane Library, Embase, Pubmed, and ClinicalTrials.gov were searched for randomized controlled trials evaluating therapies inhibiting the NLRP3/IL-1β/IL-6/CRP pathway in CAD patients. Relative risks (RR) with 95% confidence intervals (CI) were calculated.

RESULTS: 32 studies and 37,056 individuals were included. Anti-inflammatory therapies inhibiting the pathway reduced the risks of myocardial infarction (MI) (RR 0.85, 95% CI 0.78-0.93) and coronary revascularization (RR 0.80, 95% CI 0.74-0.86), with no benefits in major adverse cardiovascular events (MACE), heart failure (HF), stroke, cardiovascular or all-cause mortality. Colchicine reduced the risks of MACE, MI, and coronary revascularization. IL-1 inhibitors reduced the risks of coronary revascularization, with potential benefits in MI and HF. Increased risks of infections, gastrointestinal adverse effects, and injection site reactions were found. Meta-regression analysis demonstrated that post-treatment hsCRP/CRP was correlated with MACE (p < 0.001) and MI (p = 0.048) and post-treatment IL-6 was associated with MI (p = 0.033).

CONCLUSION: Anti-inflammatory therapies inhibiting the NLRP3/IL-1β/IL-6/CRP pathway had satisfying safety profiles and were beneficial in preventing MI and coronary revascularization in CAD patients despite no benefits in stroke, cardiovascular, or all-cause mortality.

PMID:40583093 | PMC:PMC12206679 | DOI:10.1007/s00011-025-02058-9

Med Princ Pract. 2025 Jun 27:1-16. doi: 10.1159/000547099. Online ahead of print.

ABSTRACT

OBJECTIVES: This meta-analysis compared the efficacy and safety of drug coated balloon (DCB) angioplasty with drug eluting stent (DES) for the treatment of de novo coronary artery disease.

METHODS: Following PRISMA guidelines, we conducted a systematic search of major databases, including Cochrane, MEDLINE, Embase and clinicaltrials.gov, to identify eligible randomized controlled trials (RCTs) comparing DCB and DES. Mantel-Haenszel model was used for dichotomous outcomes. Risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model using RevMan software.

RESULTS: Thirteen RCTs with a total of 4,686 patients were included. The analysis found no significant differences between DCB and DES for all-cause mortality (RR: 1.11, 95% CI: 0.81-1.53, p = 0.51) or myocardial infarction (RR: 0.80, 95% CI: 0.56-1.15, p = 0.23). Similarly, no significant differences were observed for cardiac death (RR: 1.33, 95% CI: 0.86-2.05, p = 0.19), target lesion revascularization (RR: 1.19, 95% CI: 0.64-2.21, p = 0.59), or target vessel revascularization (RR: 1.34, 95% CI: 0.79-2.28, p = 0.28).

CONCLUSION: This meta-analysis demonstrates comparable efficacy and safety outcomes for DCBs and DES in the treatment of de novo coronary artery disease. While DCBs offer a viable alternative, particularly for high-risk patients or those unsuitable for prolonged dual antiplatelet therapy, further large-scale studies are warranted to strengthen these findings and refine clinical recommendations.

PMID:40582348 | DOI:10.1159/000547099

Eur Heart J. 2025 Jun 23:ehaf446. doi: 10.1093/eurheartj/ehaf446. Online ahead of print.

NO ABSTRACT

PMID:40581490 | DOI:10.1093/eurheartj/ehaf446

Microvasc Res. 2025 Jun 26:104838. doi: 10.1016/j.mvr.2025.104838. Online ahead of print.

ABSTRACT

OBJECTIVES: We investigated the predictive value of the average microvascular resistance of the three main vessels (3VA-AMR) for the prognosis of patients with non-ST-segment elevation myocardial infarction (NSTEMI) after percutaneous coronary intervention (PCI).

METHODS: This study was conducted on patients with NSTEMI who underwent PCI between March 1, 2021, and February 28, 2022, at Fujian Medical University Union Hospital. Quantitative flow ratio (QFR) analysis was conducted on all patients' PCI angiography images to assess postoperative QFR and angio-based microvascular resistance (AMR) for three main vessels. All enrolled patients were devided into two groups based on the criteria for coronary microvascular dysfunction (CMD): high 3VA-AMR group and low 3VA-AMR group. The primary outcome was 2-year major adverse cardiac events (MACEs), including cardiovascular death, myocardial infarction, and ischemia-driven revascularization.

RESULTS: A total of 290 patients were included in the final analysis. Compared with the low 3VA-AMR group, the three vessels of high 3VA-AMR group showed lower area stenosis (49.46 ± 13.70 % vs. 52.93 ± 15.43 %，P = 0.001), higher QFR value (0.92 ± 0.05 vs. 0.88 ± 0.09, P < 0.001), and higher AMR value (274.50 [257.33-301.42] mmHg*s/m vs. 208.00 [182.00-231.83] mmHg*s/m, P < 0.001). The incidence of 2-year MACEs was significantly higher in the high 3VA-AMR group than in the low 3VA-AMR group (21.90 % vs. 10.27 %, P = 0.007). Univariate and multivariate Cox regression analyses confirmed that 3VA-AMR was independently associated with 2-year MACEs (HR:1.007, 95 % CI:1.004-1.010, P < 0.001). The Kaplan-Meier method further confirmed the difference in 2-year MACE risk between two groups. Receiver operating characteristic curve analysis showed a significant correlation between 3VA-AMR and MACE (area under the curve: 0.701, P < 0.001).

CONCLUSIONS: 3VA-AMR was an independent risk factor for 2-year MACEs in NSTEMI patients. Compared with target-vessel AMR, 3VA-AMR demonstrated superior predictive value for 2-year MACEs following PCI.

PMID:40581281 | DOI:10.1016/j.mvr.2025.104838